The acquisition of communication skills
will probably occupy an increasingly
important position in the medical
curriculum of Stellenbosch University (SU).
Thanks to an SU teaching fellowship, Dr Elize
Archer of the Centre of Health Professions
Education (CHPE) at the Faculty of Medicine
and Health Sciences (FMHS) will look at ways
of incorporating this into the curriculum over
the next three years.
At the end of 2016, Archer obtained
the first doctorate for the CHPE, which
was founded in 2006. Furthermore, she
was one of only 14 doctoral graduates
worldwide who was chosen to present her
findings at the annual conference of the
Association for Medical Education in Europe
in Helsinki, Finland. This event is attended
by representatives from approximately
90 countries.
For her doctorate, Archer focused on
ways in which patient-centredness is learnt in
a medical curriculum.
"Holistic care has always been important
to me," says Archer, who comes from a
nursing background. She was previously
involved in intensive-care training in the
private sector, and subsequently she helped
to structure the medical curriculum of the
Simulation and Clinical Skills Unit at the
FMHS. The greater her involvement became
in health professions education internationally,
the more she became interested in the
concept of patient-centredness – hence the
topic of her doctoral study.
According to her, literature has shown
that the communication skills of medical
students often decline as they proceed with
their training. Some of them become cynical
over time, suffer from burnout or gradually
lose empathy. Even though much has been
published internationally on this issue, no
similar local study has specifically focused on
medical studies.
In her investigative study, Archer involved
60 sixth-year medical students in focus
groups of 6 to 8, as well as a few specialists. "I
really don’t want to suggest for one moment
that medicine is the only scapegoat when it
comes to cynicism and poor communication
skills," she emphasises. "It's a disease found in
all medical professions."
For the purposes of her study, Archer
divided patient-centredness into two
components, namely “caring” and “sharing”.
According to her, caring doesn’t only mean
that a doctor is listening, but also that patients
feel they are heard. “Sharing” points to a
shared responsibility. “The patient must
be informed, must understand what the
condition and/or the treatment involves, and
must take ownership of it.” It is actually a
paradigm shift in many situations, says Archer,
and it requires certain skills on the part of the
doctor to conduct this conversation. “But in
the end, my study showed that our medical
students are not well equipped for this.”
Many factors play a role, including
personality, selection criteria, and a complex
clinical setting which is not really conducive to
patient-centredness. “What do you do when,
for instance, you realise you have to spend
time with a patient, but as a result you are
making things worse for the 60 still waiting in
the corridor?”
Furthermore, some students study
medicine for the wrong reasons, Archer
says frankly. “During the past couple of
years many students have told me that they
like understanding the human body, that
they want to figure out what is wrong with
someone, but that they are not interested in
hearing about the patient’s daily problems.”
Ironically enough, research shows that
the more empathy shown by someone, the
more likely that person is to suffer from
burnout. That is why some medical students
cut themselves off, and in the process may
appear emotionally blunted. “But this isn’t
fair to the patient or to the medical student,”
Archer emphasises. “That is why I and a few
other role players are currently investigating
whether we can teach them concrete skills,
including self-awareness. You have to be able
to look after yourself in order to care for
others.”
This component does, in fact, receive
attention from the first year of study, but
becomes neglected in later years when clinical
training increases.
Another important aspect is role
modelling and norms. “The seniors don’t
realise what an incredibly important role
they play in this,” says Archer. “That is why
a curriculum that is adapted to empower
students should go hand-in-hand with
staff development. The lecturers must be
made aware of their role, and they need to
consciously set an example.”
Using simulated patients is one
way in which the challenge of assessing
communication skills is dealt with
internationally. It involves the training of
paid volunteers to play the role of a specific
patient, for example a diabetic. Based on
students’ interaction with these “patients”,
the volunteers themselves, or the lecturers
who are observing, can provide feedback to
the students.
Even though communication is mostly
regarded as a soft skill, Archer regards its
inclusion in the curriculum as non-negotiable.
“The public not only requires more
knowledge and skills from doctors, but also
the right attitude.”
Caption: Dr Elize Archer
Photo: Damien Schumann